Holding Obamacare Repeal Hostage for Replace Guarantees Its Defeat

James Wallner /
January 08, 2017

After six years of pushing for a repeal of Obamacare, some on the right are now critiquing Congress’ effort for repeal. Their arguments do more to confuse the issue than to present a viable path forward for eliminating the harmful effects of this law.

Congressional Republicans appear set to finally repeal Obamacare using reconciliation, a process that allows them to overcome a Democratic filibuster in the Senate and pass budget-related legislation with a simple majority of the chamber’s members.

The repeal bill would include a transition period to give Congress time to debate how best to replace Obamacare with a series of patient-centered reforms, each of which would address specific problems in the health care system.

But critics of this approach derisively dub it “repeal and delay” and assert that it is based on a fatally flawed strategy that inevitably presents the GOP with several insoluble problems.

They claim that repealing Obamacare in this way guarantees market instability, higher premiums, and ultimately the loss of coverage for millions of Americans. This is because the insurance regulations mandated by the law may not be included in the reconciliation bill.

As a consequence, the critics argue that so-called “repeal and delay” carries with it significant political risks that will come back to haunt the GOP.

If that weren’t enough, the critics also contend, counterintuitively, that repealing Obamacare first makes replacing it more difficult.

According to the American Enterprise Institute’s Joseph Antos and James Capretta, the effect of repealing Obamacare before replacing it makes “it much more difficult to build a broad political coalition for the replacement plan.”

Antos and Capretta say that under such an approach, Republicans would eventually be forced to “reverse course and take steps to provide some kind of emergency insurance” for those negatively impacted by repeal because of the political backlash that would result.

Similarly, Heather R. Higgins and Phil Kerpen argue in a separate piece that “Democrats would have little incentive to come to the table on a ‘replace’ bill” in such an environment. And Peter Suderman, writing at Reason, argues that the current approach would set up “a political and policy equilibrium that is likely to make more effective reforms even more difficult.”

The implicit assumption in each of these critiques is that Democrats are willing to repeal Obamacare now just so long as we replace it with market-based reforms that Republicans can support.

Given this, some Republicans have proposed their own repeal plans. And they all largely reflect this common belief that Obamacare can only be repealed and replaced if it’s done simultaneously.

But the fundamental problem with this approach is that it actually poses greater political risk for the GOP, makes repeal less likely, and ensures that the replace debate will occur in the context of the framework created by Obamacare.

Holding repeal hostage for replace perpetuates the current market instability, increasing premiums, and coverage losses that have been the result of Obamacare. This poses significant political risks for a GOP that has consistently promised its supporters it would repeal the law as soon as it was able.

As pointed out by The Wall Street Journal, “affordability, choice and competition are due for another tumble next year under the status quo.” The health insurance market is getting worse day by day, and the American people expect Congress to stop the situation from deteriorating further.

In this environment, it will be difficult for Republicans to persuade their constituents that they are truly committed to repealing Obamacare when they now control the House, Senate, and presidency, and still can’t bring themselves to repeal it.

In addition, tying replace to repeal by voting on them simultaneously makes success in either effort unlikely. Congressional Democrats are unlikely to negotiate when the price of doing so is to facilitate Obamacare’s demise.

Their participation in efforts to replace the health care law while it is still on the books would acknowledge that it has been a failure, something rank-and-file Democrats have been unwilling to concede up until now despite all of the mounting evidence to the contrary.

Some critics concede that the absence of significant bipartisan support for the current replace plan means that almost every elected Republican will have to support it. Barring unified GOP support, it is unlikely that the legislation can pass the House or Senate.

Moreover, the partisan nature of this replace effort requires it to be accomplished through the same reconciliation process that critics are currently attacking, since Senate Republicans are unlikely to overcome a Democratic filibuster.

At best, such a process ensures that the GOP replacement plan can pass only by using the same controversial process that Democrats used to ram Obamacare through the Congress in the first place. That process, just as much as Obamacare’s substance, has been responsible for poisoning the debate ever since.

Legislation that combines repeal with a comprehensive package of reforms would inevitably be an enormous thousand-plus-page bill that will have been written in secret. And it will ultimately need to be quickly forced through the House and Senate, giving members and their constituents little time to read, much less understand, its numerous complicated provisions.

While the editors at National Review are correct in their assessment that building near-unanimous Republican support around such a replace plan will take time, they are wrong to assume that the end result will be “a real win.”

Instead, the most likely outcome is that Obamacare will continue to be the law of the land and any changes to it will be considered in the context of that baseline. As a consequence, efforts to enact the fundamental reforms that are needed to fix our health care system will be seriously disadvantaged.

The process to fully repeal Obamacare must begin now. The current plan to do so using budget reconciliation is a necessary first step in that process. The House and Senate did just that in the last Congress when they repealed the guts of Obamacare, and they should do at least that much again this year. Only then can the real effort begin to replace it.

Political risk, real or imagined, should not be used as an excuse for members of Congress to avoid doing the job they signed up for in November. No one said it was going to be easy. But a promise is a promise.